January 14, 2011
Volume 55, Issue 2

Quality Improvement Act Clears First Hurdle
Special Session Senate Bill 1 passes committee on party-line vote

This morning the Senate Judiciary, Utilities, Commerce, and Government Operations Committee voted 3-2 to approve Special Session Senate Bill 1 (SS SB 1), Governor Walker’s tort reform package that was unveiled last week. An important part of that package is the Health Care Quality Improvement Act (QIA).

Senators voting in favor of the bill were Committee Chair Rich Zipperer (R-Pewaukee), Neal Kedzie (R-Elkhorn) and Pam Galloway (R-Wausau). Voting no were Fred Risser (D-Madison) and Jon Erpenbach (D-Middleton).

Earlier in the week, the bill and its companion, Special Session Assembly Bill 1 (SS AB 1) received a joint hearing before this Senate committee and the Assembly Judiciary and Ethics Committee, Chaired by Rep. Jim Ott (R-Mequon).

WHA is again joined by a long and growing list of supporters in calling for the QIA, which will update Wisconsin’s peer review laws to more closely align with our highly integrated health care delivery system. (See story in last week’s Valued Voice: www.wha.org/pubArchive/valued_voice/vv1-7-11.htm#1; Link to WHA hearing memo: www.wha.org/QIAjointHearingMemo1-11-11.pdf; QIA group hearing memo: www.wha.org/QIAgroupMemo1-11-11.pdf.)

By enabling more cost-efficient and effective medical care through increased collaboration, WHA believes enacting the QIA will improve the overall value of health care for employers and their employees.

In opening testimony, Brian Hagedorn, chief legal counsel for Governor Walker, described the QIA provisions as a proposal that will "…protect peer review from the threat of litigation with the goal of increasing the efficiency and quality of health care."

"Health care providers in the state are anxious to be able to implement stronger peer review and quality improvement activities under the proposed changes," said WHA’s Chief Quality Officer Kelly Court in her testimony before the joint hearing.

"The existing law was created in the 1970s; our knowledge and systems to evaluate and analyze quality data and trends have expanded greatly since that time. The improved law is designed to promote more robust reporting of events and quality statistics and allow for greater collaboration. This is a very important step to making Wisconsin health care even better than it is today," Court said.

Also appearing at the hearing in favor of the proposal was Ralph Topinka, vice president and general counsel for Mercy Health System in Janesville. "Health care providers in this state expend tremendous efforts designed to improve the quality of care they provide to patients," Topinka said. "The Quality Improvement Act is a major step forward in promoting robust peer and internal review of care which are crucial components of those efforts."

"We believe a system that encourages people to report individual and group performance creates greater opportunity for improvement," added Sharon Kostroski, vice president of quality and safety for Ministry Health Care who was among those testifying. "By sharing data more broadly with other organizations, the data becomes more robust, and the evaluation of the data will lead to process improvement that allows providers to improve quality and safety."

Thomas Shorter, an attorney with Godfrey Kahn who represents hospitals and integrated health systems, said "The Quality Improvement Act provisions of this bill would encourage open and frank discussions among health care providers, incentivizing providers to share information within and across organizations in order to improve the quality of health care. Higher quality of course leads to lower costs, which is good for all purchasers of health care."

"The Quality Improvement Act had strong bipartisan support in the 2005 and 2007 legislative sessions," noted WHA Senior Vice President and General Counsel Laura Leitch. "These are positive changes that most importantly will benefit our patients."

A committee vote on SS AB 1 is scheduled for Tuesday, January 18. Votes on the proposal by the entire Legislature are also expected next week.

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Audit Committee Approves Medicaid Program Audit

The Joint Legislative Audit Committee, now Chaired by Sen. Rob Cowles and Rep. Samantha Kerkman, unanimously approved an audit of the State’s Medicaid program this past week, one year after the same committee under different leadership failed to approve a similar audit.

In their support of the audit, both Sen. Cowles and Rep. Kerkman cited the increasing costs of the program and the need to identify savings. Both also felt that the scope of the audit should be flexible and allow the Legislative Audit Bureau to review the entire program.

Legislative Audit Bureau Director Jan Mueller indicated that the audit would be comprehensive and that her staff would be looking at underlying cost efficiencies in the program. In a letter to the Committee, Director Mueller laid out the scope of the audit to include trends in funding and a detailed review of administrative costs, caseload increases and service costs, contract payments, and a comparison of Wisconsin Medicaid costs, benefits and cost containment to that of other states. Access the letter here: http://legis.wisconsin.gov/lab/reports/11-scope_MA.pdf.

Testifying for the Department of Health Services were Kitty Rhoades, Deputy Secretary, and Brett Davis, the new state Medicaid Director. Both Rhoades and Davis expressed a willingness and openness to the audit. Davis said that working with the auditors would be a Department priority. Rhoades and Davis fielded questions from Democratic Committee members questioning whether the Department is hoping to use the audit to reduce program enrollment. Rhoades and Davis responded that they are committed to finding ways to operate a "sustainable" program.

Parts of the audit are expected to be completed in time for use in the current biennial budget with the remainder of the audit being released in the fall.

In addition to the Medicaid audit, Director Mueller said that her staff is also working on completing an audit of the FamilyCare program, which is due in March of this year.

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CMS Releases Proposed Rule for Hospital Value-Based Purchasing Program

The Centers for Medicare & Medicaid Services (CMS) on January 7 released a proposed regulation for the new hospital value-based purchasing (VBP) program.

The Patient Protection and Affordable Care Act of 2010 (ACA) requires the Secretary of Health and Human Services to establish a VBP program to pay hospitals for their actual performance on quality measures, rather than just the reporting of those measures, beginning in fiscal year (FY) 2013. The VBP program will apply to all acute-care prospective payment system (PPS) hospitals.

The rule proposes the quality measures that would be used for the program. For the first year, FY 2013, CMS proposes 17 clinical quality measures as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experiences with care survey for inclusion in the VBP program. The clinical quality measures selected include three measures of heart attack care, three measures of heart failure care, four measures of pneumonia care, and seven measures of surgical care. The ACA stipulates that the program include health care-associated infection measures. For FY 2013, four of the surgical care measures would fulfill that requirement.

A full list of the measures proposed for FY 2013 as well as detailed information related to how performance scores will be calculated is posted at www.wha.org/financeAndData/pdf/CMSReleasesProposedRuleVBP1-10-11.pdf.

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ACOs, Physician Alignment Highlighted at WHA Physician Leadership Conference
Last Chance for Early Bird Discount

January 28 is the deadline for the early bird registration discount for the 2011 annual Physician Leadership Development Conference. Now is the time to take advantage of nationally-recognized, CME-qualifying education offered in-state, while saving money on airfare, lodging and registration fees.

This year’s conference will be held March 11-12 at The American Club in Kohler. The full conference agenda and online registration are available at www.wha.org/education/PhysicianLeadership.aspx.

Accountable care organizations (ACOs) will be one of the topics explored in depth at this conference. Todd Sagin, MD, JD, from the American College of Physician Executives, will describe how physicians and hospitals across the United States are responding to the demand for ACOs. Sagin will help physician leaders and members of the executive team understand the ACO concept, as well as plan and implement necessary changes to meet evolving government and payer expectations.

William "Marty" Martin, PsyD, MPH will discuss the physician’s role in creating an environment that promotes clinical excellence. Physician leaders will learn how to focus their management skills on ensuring that the physicians’ goals are in alignment with the mission of the broader organization.

This popular conference garners outstanding evaluations from attendees each year. Its focus is to develop physicians’ leadership skills and assist them in making the transition from clinician to physician leader. The price is reasonable and physicians will have limited travel time and less expense associated with attendance in a Wisconsin-based conference than at a national offering.

Physicians and health care leaders that have attended in the past are encouraged to consider attending again, as new topics will be presented. Both speakers are on faculty with the American College of Physician Executives (ACPE). ACPE is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. ACPE designates this educational activity for a maximum of 11 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

For more information on registration, contact Lisa Littel at 608-274-1820 or email llittel@wha.org.

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Mark Your Calendars: WHA Advocacy Day on April 27

Join your fellow hospital employees, trustees and volunteers from across the state in Madison on April 27 at the Wisconsin Hospital Association’s premier grassroots event, 2011 Advocacy Day. Hear from nationally-recognized speakers and elected officials, then take what you’ve learned and head to the Capitol to meet personally with your legislators on issues of importance to your hospital and community.

"I encourage every hospital to send a contingent to this important day in Madison," said Steve Brenton, president, Wisconsin Hospital Association. "When 700 hospital employees and volunteers travel to Madison to talk with their legislators, it makes a very powerful statement."

2011 Advocacy Day will take place at Madison’s beautiful Monona Terrace Convention Center. The State Capitol is only a short two blocks away and transportation from the Monona Terrace to the Capitol for your legislative visits will be available.

"In 2010, the Aspirus volunteers took our first full bus (55 volunteers) to Advocacy Day," said Yolanda Voigt, director of volunteers for Wausau Aspirus Hospital. "We heard ‘an insider’s view’ of Washington, listened to gubernatorial candidates and heard from Governor Jim Doyle—all in the company of other hospital volunteers."

"Our attendees were so impressed we have another bus planned for this year—maybe even two buses! Thanks to WHA and their staff who planned such a fun, informative day," said Voigt.

Make sure to mark your calendars today for Advocacy Day on April 27. Watch for registration details in the coming weeks!

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New Grant Will Help Hospitals Develop Community Health Needs Assessments

A newly-funded grant will bring tools, resources and most importantly, definition to the process that communities follow as they develop their community needs assessment and community health improvement plans (CHIP). The grant, which was funded by the Wisconsin Partnership Program, was submitted by the Wisconsin Association of Local Health Departments and Boards (WALHDAB) and Julie Willems Van Dijk, the academic partner from the UW Population Health Institute.

The grant, which received strong support from WHA, will help support the development of partnerships among hospitals, public health, local government and other community organizations to identify and address their community’s health needs. The resources that are developed during the three-year grant period will bring many mid-sized and small communities a level of expertise and tools that would otherwise not be readily accessible.

"The work entailed in this grant moves us a step closer to improving the process of and developing tools that will help prioritize the health needs and guide the allocation of resources to respond to those health needs," according to WHA President Steve Brenton. "Identifying a systematic process to gather information, guide dialogue, rank the community health needs, and then move into action would be a major accomplishment."

Hospitals are now required to complete a community health needs assessment every three years. Many hospitals already do a community health needs assessment, but many are looking to improve how they accomplish it.

According to Willems Van Dijk, "Working together with public health on a community health improvement plan will allow all organizations to pool and conserve their limited resources and create a community coalition that will provide important input, and facilitate broader support for the final plan and action."

WHA will be working closely with WALHDAB and Willems Van Dijk to provide WHA members the opportunity to participate in surveys, focus groups, or serve as pilot testing sites for the revised CHIP materials. For more information, contact Mary Kay Grasmick, WHA vice president, communications, mgrasmick@wha.org, or 608-274-1820.

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First Draft of Stage 2 Meaningful Use Opened for Comment

A first draft of recommended Stage 2 EHR meaningful use requirements was officially released on January 12 by the Office of the National Coordinator’s (ONC’s) Health Information Technology Policy Committee. This committee advises the Department of Health and Human Services (HHS) on implementation of the Medicare and Medicaid EHR Incentive Programs, and is charged with making an initial set of recommendations to HHS as HHS begins developing rulemaking to define Stage 2 meaningful use.

The Committee is seeking comments through February 25 on its recommended Stage 2 meaningful use requirements. Following the receipt of comments, the committee plans to hold public hearings this spring and to issue final recommendations to HHS this summer. Later in 2011, HHS is expected to formally issue a proposed rule defining Stage 2 meaningful use with further opportunity for public comment, followed by issuance of a final rule.

WHA is planning on providing comments to the recommendations, and is convening its HIT Task Force in early February to review the recommendations and help develop comments. Look for more information on the Committee’s recommendations in the Valued Voice in early February.

The Committee’s recommendations and instructions for commenting can be found here: http://healthit.hhs.gov/media/faca/MU_RFC%20_2011-01-12_final.pdf.

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Newly-Elected Representative Travis Tranel Shadows at Boscobel

Wisconsin Rep. Elect Travis Tranel shadowed Boscobel Area Health Care CEO John Russell on December 22 to learn about rural health care in Wisconsin.

The "shadow day" initiative was launched by WHA in the fall of 2010. To date, seven CEO-legislator shadow days have been held, and many more are already in the planning stages.

During Rep. Tranel’s time at Boscobel, he heard from CEO John Russell about the impact of the new federal health care reform law, saw how Medicare/Medicaid policies impact small, rural providers and learned how other state and federal legislation will affect community hospitals and their patients.

Tranel also met with the hospital administration team and the board president. He toured the hospital and visited with staff and physicians.

If your hospital is interested in hosting your legislator at a shadow day, please contact WHA’s Jenny Boese at 608-268-1816 or

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Weekly Influenza Updates Available on WHA Web site

While there is significant influenza activity in Southeast United States, Wisconsin continues to have very low influenza activity, according to the weekly influenza update that is provided to WHA by Jonathan Temte MD, PhD. Temte—a professor of Family Medicine at the University of Wisconsin School of Medicine and Public Health—serves on the U. S. Advisory Committee on Immunization Practices. Throughout the influenza season, he shares his weekly updates with WHA. Temte’s updates are posted in the disaster preparedness section of WHA’s Web site at www.wha.org/disasterpreparedness/h1n1.aspx.

Temte said there is an excellent match between the circulating strains of the flu and the vaccine this year. All three strains (AH1, AH3 and B) are being detected at low levels. The prevalence of influenza-like illness [fever of 100oF or higher and either cough or sore throat] in Wisconsin’s primary care patients is estimated to be 1.2 percent and is currently stable.

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Ann Bergmann Appointed to AHA’s Committee on Volunteers

The Board of Trustees of the American Hospital Association (AHA) recently appointed Ann Bergmann of Cumberland to serve as a member of the Committee on Volunteers. In this leadership role, Bergmann will participate in Washington, D.C. with the development of policies to represent, guide and assist the nation’s hospitals. The committee is also involved in public policy development and grassroots advocacy.

The Committee on Volunteers (COV), composed of 15 members from throughout the United States, is the recognized body of AHA that is concerned with the role and responsibilities of organized volunteers and auxiliaries.

Bergmann is currently the Partners of Wisconsin Hospital Association Immediate Past President now serving the organization as Web site coordinator/Resource Center director. Ann is a member of Cumberland Memorial Hospital-ECU Volunteer Partners.

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Reception Celebrates Bill Bazan’s Service to WHA, Milwaukee Community

Bill Bazan was joined by family, friends and colleagues at a reception held in his honor in Milwaukee January 13. Nearly 60 people gathered to celebrate Bill’s retirement and offer their thanks and congratulations for his years of service as a health care advocate.

Wisconsin Governor Scott Walker and Milwaukee Mayor Tom Barrett issued proclamations that commemorated his distinguished career and recognized his role as a health care advocate in Wisconsin and in the City of Milwaukee.

We wish you well in the future, Bill. You will be missed.

Your Colleagues at WHA

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Wisconsin Health Care Leaders Release Wisconsin Health Reports Web Site

WHA joined the Wisconsin Collaborative for Healthcare Quality (WCHQ) and the Wisconsin Medical Society in creating a new Web site for health care consumers. Visitors to the Wisconsin Heath Reports Web site receive practical advice for becoming more involved in health care. Visitors can learn from the experience of two fictional characters, Helen and Bob, who are diabetes and heart care patients, as they become more engaged in their own care. The new Web site has been developed based on guidance from consumer experts and research findings available through a grant from the Robert Wood Johnson Foundation through Aligning Forces for Quality. We invite you to take a moment to visit the new Web site at www.wisconsinhealthreports.org.

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Wisconsin Hospitals Community Benefits: Uncompensated Care

Fear of a bill should never prevent a patient from seeking care at a Wisconsin hospital. Wisconsin hospital charity care programs provided $226 million to more than 700 patients a day in 2009. The stories that follow illustrate the deep commitment and continuing concern that hospitals have to their patients to ensure they receive the care they need regardless of their ability to pay.

Silas Gates — In this together

Waiting for employment and insurance, his health deteriorated.

Statistics from the financial assistance program at Hudson Hospital & Clinics reflect difficult times for many local families. Between 2008 and 2009, applications to the program doubled. That number is on track to quadruple in the year ahead. But the program responds to people – not numbers, says Charlene Barnes, the organization’s patient financial services representative.

Last year, one of those people was Silas Gates, who – ironically – had health insurance most of his life and rarely needed it.

But the 58-year-old carpenter and cabinet maker lost his job – and insurance – four years ago. So when his back started hurting last year, he put off a trip to the doctor for more than eight months. Now he wishes he had paid for a few blood tests then. It turns out, what he thought was standard back pain was really a symptom of an increasingly dangerous case of anemia.

In November, he finally sought help at a free clinic in River Falls. Clinicians there advised him to go to the emergency department – immediately. After receiving 5 pints of blood at the emergency department at Hudson Hospital & Clinics, he says, his back pain started going away. But doctors soon realized the untreated anemia had damaged his heart and lungs.

"I’m really appreciative they took me in without insurance and did all those tests," Gates says. "Without that, I probably would have died from anemia."

Unfortunately, Silas’s wife of 40 years, Jackie, was also unemployed and uninsured. For 30 years, she was a jewelry saleswoman. They have lived for the past five years in Hudson, together with Jackie’s father, who has medical problems and needs their help.

"I figured I’d be back to work, she’d be back to work, and we’d be back to normal," Gates says. But with no jobs yet in sight, they turned to the financial assistance program at Hudson Hospital & Clinics for help. They weren’t eligible for other assistance programs. And the couple was too young for Medicare and too young for Social Security.

"Charlene got all of the hospital bills taken care of," Silas Gates says. "Now I have doctor bills and x-ray bills down to a point where it’s feasible to pay them off without losing our house. That would be my only other option."

Gates says his health is improving. His back no longer hurts, though his legs are recovering from the swelling that came along with anemia. He knows his heart and liver need additional attention, but he is waiting to find affordable health insurance before scheduling appointments with specialists.

"I have a lot of gratitude for Hudson Hospital & Clinics and I’d like to figure out a way to return the favor," Gates says.

Hudson Hospital & Clinics, Hudson

Mr. Richard Ostenson

Richard Ostenson, of Clayton, Wis., had been doctoring at St. Croix Regional Medical Center for some years. The 43-year-old works full-time as bartender and had health insurance he purchased on his own, a major medical plan which had a "pre-existing condition" clause which ultimately didn’t pay much at all given its cost.

Five years ago, he was advised by his doctor to have an early colonoscopy because his father had died of colon cancer. Despite having coverage, his insurance company agreed to pay only a small part of the bill.

"I had no idea that I’d have such huge problems getting my insurance company to pay," Ostenson said, "and between the deductible and their twisting the rules, it cost me a lot."

Ostenson was saddled with a lot of debt. "With a mortgage payment, food costs, and so on, there just isn’t anything extra for medical bills," he said. "Even a simple office visit is expensive for me. And I’m still paying on my colonoscopy bill, too."

"We know that Mr. Ostenson’s employer doesn’t provide health insurance, and it’s understandable that he hasn’t been able to find a policy he could afford on his own," said Brenda Bonetti, patient advocate at St. Croix Regional Medical Center. "He doesn’t have any chronic problems, but things just happen. The last time he was in, for example, he’d been bitten by his dog, and recently he had to have a sebaceous cyst removed. Mr. Ostenson has applied a number of times for our hardship discount and has been awarded a 50% reduction, which he is managing to pay."

"Brenda [Bonetti] has been a miracle worker for me," said Ostenson. "She’s helped me find money to pay for what I owe. St. Croix Regional Medical Center’s hardship program has been a huge help. With a reduced bill, I might even be able to afford to come in to the clinic maybe once a year for a checkup. I have no idea what I’d do without this."

St. Croix Regional Medical Center, St. Croix Falls

Helping Hand – letters of thanks

"Simply, Thanks!"

~A married couple, both employed, but struggling with thousands of dollars in medical bills not covered by their insurance after their numerous appeals. Aurora Helping Hand covered the balance.

"I (name withheld) and my dad (name withheld) do appreciate that the hospital bill was completely paid in full. Your organization is very helpful. And again, we really do appreciate it very much."

~A 36 year-old male, unemployed and uninsured, living with his father, who needed day surgery.

Aurora St. Luke’s Medical Center, Milwaukee & Aurora St. Luke’s South Shore, Cudahy

Submit community benefit stories to Mary Kay Grasmick, editor, at mgrasmick@wha.org.

Read more about hospitals connecting with their communities at www.WiServePoint.org.

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